Insurance Claims Specialist, PB

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee patient account balances by ensuring precise claim submissions, adhering to regulatory standards, timely follow-ups, and managing denials.

• Accurately and promptly submit claims to third-party payers.

• Address claim edits and account discrepancies prior to submission.

• Follow up with third-party payers to enhance collections and achieve departmental objectives.

• Communicate with payers to resolve outstanding claims and utilize payer portals/websites to check claim status.

• Assist Patient Access and Care Management teams with the investigation and resolution of denials.

• Compile statistics, complete reports, and perform clerical tasks.

• Research and manage returned mail and claims rejected by payers.

• Reconcile transactions in billing accounts and handle billing and follow-up activities.

• Monitor accounts to ensure timely follow-up and optimize cash receipts.

• Maintain work queue volumes and productivity in accordance with established guidelines.

• Provide exceptional customer service to patients, visitors, and staff.

• Attend department meetings, teleconferences, and webcasts as required.

• Engage in performance improvement initiatives and collaborate with management to reach annual goals.

• Uphold the confidentiality of demographic, clinical, and financial information.

• Report workflow issues to management promptly.

⛳️ Requirements

• High School diploma or equivalent is required.

• A minimum of one year of experience in medical billing or a medical office is preferred.

• Strong oral and written communication skills are essential.

• Proficient knowledge of computer systems is required.

• Exceptional customer service skills and telephone etiquette are necessary.

• Ability to employ tact and diplomacy in interactions with others.

• Familiarity with medical terminology is preferred.

• Understanding of business mathematics is preferred.

• Knowledge of ICD-10 and CPT coding processes is preferred.

• Familiarity with revenue cycle operations, third-party reimbursements, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and reimbursement procedures is essential.

• Ability to sit for extended durations is required.

• Strong reading and comprehension skills.

• Visual acuity within a normal range is necessary.

• Effective communication skills are required.

• Manual dexterity is needed for operating keyboards, fax machines, telephones, and other office equipment.

• Capability to understand both written and verbal communication.

🏝️ Benefits

• Scheduled weekly hours: 40.

• Participation in educational programs to fulfill mandatory requirements and address personal and professional development needs.

• Reasonable accommodations may be provided to enable individuals with disabilities to perform essential functions.